Title : Acute HSV-1 vulvitis with sepsis in a young woman with uncontrolled type 1 diabetes: A multidisciplinary case report
Abstract:
Background: Herpes simplex virus (HSV) vulvitis is typically self-limiting but may present severely in immunocompromised individuals. This case highlights an unusual presentation of HSV-1 vulvitis complicated by sepsis in the context of poorly controlled type 1 diabetes mellitus.
Case Presentation: A 27-year-old female with known type 1 diabetes (HbA1c 12%) presented with vulval pain, erythema, and fever. She developed urinary retention due to severe vulval pain. Examination revealed extensive vesicular lesions in vulva and perineum and signs of systemic infection. Catheter was passed to relieve urinary retention. HSV PCR swabs from vulva came back positive for HSV-1; serology was negative for HSV IgG, suggesting a primary infection.
The patient was diagnosed with HSV vulvitis complicated by secondary soft tissue infection and sepsis. Initial management involved intravenous Cefazolin and Acyclovir for seven days. Upon clinical improvement, therapy was stepped down to oral Augmentin Duo Forte and Valaciclovir to complete a total 10-day course.
Given the patient’s poor glycaemic control, the endocrinology team initiated insulin optimisation with Novorapid and Optisulin. Outpatient follow-up was arranged with her general practitioner and the diabetes clinic.
Discussion: This case illustrates the potential for severe HSV presentations in patients with poorly controlled diabetes. The overlap between infectious disease, endocrinology, and gynaecology care was critical to the patient's recovery. Early identification, multidisciplinary management, and tight glycaemic control were key to preventing further complications.
Conclusion: Clinicians should consider HSV infection in the differential diagnosis of genital ulcers, especially in immunocompromised patients. This case reinforces the systemic implications of uncontrolled diabetes and the importance of collaborative care.
